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Status of the cervix in the forecast of labor in post-term pregnancy
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Karimova Feruza Dzhavdatovna, Professor, Department of Obstetrics and Gynecology of the Tashkent Institute of Postgraduate Institute Mamadazimova Dilorom Fayzymamatovna, Senior Research Scientist of the Department of Obstetrics and Gynecology of the Tashkent Institute of Postgraduate Institute E-mail: [email protected]
Status of the cervix in the forecast of labor in post-term pregnancy
Abstract: Depending on the length of the cervix at transvaginal sonography [10-20 mm, 21-30 mm, 31-40 mm, 40 mm] for pregnant women identified the forecast delivery.
Keywords: post-term pregnancy, cervical bimanual technique, transvaginal ultrasonic research.
The incidence of pregnancy is from 3.5 to 16% and has a downward trend [1, 3-4] Adverse perinatal outcomes when post-term pregnancy increase with increasing gestational age. This perinatal mortality rate 6 times higher than that at term, due to the low resistance of the brain to mature fetal hypoxia [2, 1-3; 4, 1-2].
Perinatal central nervous system [CNS] post-term children have determined the high frequency of neurological disorders. In connection with above, it becomes important selection of the optimal time and method of delivery of patients with post-term pregnancy that is determined by the degree of readiness of the cervix for childbirth and fetus. Widely used bimanual method of assessing the state ofthe cervix with vaginal research, being subjective, does not allow to fully appreciate the cervical length and the state of the internal os [5, 1-2]. Therefore now it attaches great importance to the echographic assessment of the cervix during transvaginal ultrasonography study.
Objective: The objective was to determine the characteristics of the state of the cervix in pregnant women with gestational age more than 41 weeks at transvaginal sonography.
Materials and Methods: We have conducted a comprehensive survey of119 prospective pregnant with gestational age more than 41 weeks (287 days).
We were excluded from the study patients with a scar on the uterus, Multiple pregnancy, wrong position fetus, pelvic presentation who came in as a result of assisted reproductive technologies.
Results and discussion: gestational age was calculated from the first day of the last menstrual period (formula Negele) based on the data of ultrasound scanning, performed in the period from 7 to 20 weeks of pregnancy. When determining the degree of maturity of the cervix using score scale necessity E. Bishop.
With transvaginal ultrasound cervical length was measured, the state of the internal os and cervical canal. Patients with the opening of the internal os was evaluated in the same form recesses (V, Y, U — shaped) and the degree of opening. When proposed cervical preparation used for childbirth, prostaglandin E2, or a combination thereof. The remaining patients developed own labors.
Depending on the length of the cervix transvaginal sonography (10-20 mm, 21-30 mm, 31-40 mm and over 40 mm) surveyed pregnant were divided into 4 groups.
With a length of 10-20 mm of the cervix, all patients have given birth vaginally. Spontaneous activities onset of labor was observed in 4 [3.4%] of pregnant women, amniotomy was performed in two, the introduction of prostaglandin gel — eight patients.
Section 6. Medical science
Among the patients of the second group (cervical length 2130 mm) birth vaginally occurred in 90%. At the same time 35% of the generic activities developed spontaneously. Caesarean section was urgently conducted in 4 (3,4%) patients after use as a preparation for childbirth laminaria and easy-glandinovogo gel. The indications for cesarean section were clinically narrow pelvis [4,2-4], chronic fetal hypoxia [3, 1-2].
In the group of patients in whom transvaginal ultrasound cervical length was 31-40 mm, the cesarean rate was significantly higher than in the second group, and reached 27.5%. At the same time of 11 caesarean sections were performed in 10 urgently order in connection with a clinically narrow pelvis, uterine inertia, chronic fetal hypoxia. Generic activities in all patients, delivery by surgery, developed on the background of the use of prostaglandin gel.
The highest incidence was observed among cesarean patient fourth group for which the length of the cervix according transvaginal ultrasound exceed 40 mm (44%). For this group of patients was characterized by the same frequency planning and urgently abdominal delivery. Planned indications for cesarean section was 42 weeks gestational age or more and lack of preparation of the birth canal. The indications for emergency caesarean section was the weakness of labor activity.
Conclusions:
1. Length cervix at prolonged largely reflects the willingness of pregnant women for childbirth.
2. State cervical uteri using transvaginal sonography, should be considered when determining the obstetric tactics in women with post-term pregnancy.
References:
1. Strizhakov A. N., Davydov A. I., Belotserkovtseva L. D. Clinical lectures on obstetrics and gynecology. - M., 2004. - 621 p.
2. Kravchenko E. N. Prevention intrapartum fetal damage in complicated childbirth: Author. Dr. med. Sciences: 14.00.01. - Omsk, 2009.
3. Gorelov P. P. Condition offetoplacental complex in the prolonged pregnancy//Actual problems of obstetrics. - SPb., 1996. - P. 16-17.
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Mamadazimova Dilorom Fayzymamatovna, Senior Research Scientist of the Department of Obstetrics and Gynecology of the Tashkent Institute of Postgraduate Institute Karimova Feruza Dzhavdatovna, Professor, Department of Obstetrics and Gynecology of the Tashkent Institute of Postgraduate Institute E-mail: [email protected]
Some features of hemodynamics in prolonged pregnancy according to doppler
Abstract: The study of the functional state of fetoplacental complex and fetus at term pregnancy allows to develop the forecast for the next delivery.
Keywords: fetoplacental complex, fruit, prolonged pregnancy.
Increased vascular resistance of the fetus due to their spasm, is one of the compensatory mechanisms — centralization of circulation with the primary blood supply to vital organs at increasing hypoxia and metabolic disorders. The growth of fetal hypoxia is accompanied by a decrease in resistance vessels of the brain, providing it with adequate oxygenation. The preferential blood flow to the brain of the fetus in terms of progression of placental insufficience (PI) has been called «brain-sparing effect» [3, 2-4; 1, 1-2].
Objective: to study the functional state of fetoplacental complex and fetus at term pregnancy.
Material and Methods: group 1, the main-18 womens with post-term pregnancy 2-group- control 14 womens with normal gestation.
Results and discussion
Analysis of the Doppler study in a group of pregnant women with post-term pregnancy revealed significant differences between hemodynamic parameters in the mother-placenta-fetus as compared with those of a control group which included pregnant women with gestational age 39-40 weeks.
In the study group (prolonged pregnancy 42 weeks) in 14 patients (46,67 ± 9,11%) of pregnant women there was a significant violation of utero-placental blood flow.
When comparing the FRC (flow rate curve) in utero-placental blood flow was determined by a significant increase in the ADR (average diastolic ratio) (2,90 ± 0,08), PI (pulse index) (1,643 ± 0,06) and RI (resistance index) (0,67 ± 0,03) in comparison with indicators comparison group and the control group (p <0.001).
Thus, detection of pathological changes of hemodynamic parameters in the uterine arteries in the study group reveal a violation of the process of ensuring adequate oxygenation and nutrition of the developing fetus at term pregnancy.
When Doppler study of fruit-placental and fetal hemody-namics in the study group were isolated from pregnant unaltered fruit-placental blood flow and cerebral blood flow: — Fetal hemodynamics without pathological changes — 12 (40,00 ± 8,94%) observations;
— Changes in hemodynamics fruit — 18 (60,00 ± 8,94%) cases.
In 12 (40,00 ± 8,94%) observations in the analysis features of fetal hemodynamics was no significant difference from those of its parameters in the control group, in fruits and placental blood flow was normal.
